Anxiety, depression, and suicide attempts have increased over the past decade, especially among teenagers, often resulting in visits to the emergency department (ED). Due to a nationwide shortage of beds in psychiatric treatment programs, virtually all pediatric hospitals are forcing patients to remain in emergency departments, inpatient floors, and surgical floors, sometimes for weeks at a time, while waiting for a vacancy. This is an act known as boarding.
Pediatric mental health crises and boarding have further increased during the COVID-19 pandemic. “As volume increased, we couldn’t keep up,” says Patricia Ibesiaco, M.D., who directs the quality and safety program in the Department of Psychiatry and Behavioral Sciences at Boston Children’s Hospital.
In 2021, Boston Children’s Hospital increased its investment in crisis care, adding 12 inpatient psychiatric beds and the equivalent of nine full-time multidisciplinary staff members to its emergency psychiatric services, psychiatric consultation services, and psychiatric resource specialist teams to assist with stabilization and transfer of inpatients. These staff conducted risk and safety assessments, initiated medication and psychotherapeutic interventions, educated patients and families about the illness and care, facilitated appropriate placement, and coordinated care with local mental health providers.
Ibesiako and colleagues at Boston Children’s Hospital demonstrated in a retrospective study that these interventions had a positive impact.
Reduce boarding time and increase access to psychiatric treatment
The study compared mental health hospitalization times for children up to age 17 before and after adding additional psychiatric beds and staff (October-December 2021 vs. October-December 2022).
Over the year, the length of boarding for children requiring high-level (hospitalization/acute care facility) or intermediate-level (partial hospital/home crisis stabilization) psychiatric care decreased by 53%, from 9.1 days to 4.3 days. Did. After residential crisis intervention, length of stay in Boston Children’s Hospital’s inpatient psychiatric unit and acute residential treatment program also decreased by 27 percent (by an average of 5.4 days), allowing more children to access these programs (54 vs. 42 percent).
In contrast, an April 2024 survey of hospitals nationwide found that increase Length of stay for pediatric mental health ED visits from March 2020 to 2022.
“By aggressively implementing comprehensive interventions to address boarding, we were able to reverse this trend,” says Ibesiako, who is also an associate professor at Harvard Medical School.
Ibesiako said staff recruitment and retention is an ongoing challenge due to a shortage of mental health professionals. And the accommodation issue was not completely resolved. Children and teens with aggressive behavior (approximately one-third of the study population) continued to spend longer periods of time in the ED and on medical floors and clearly needed more resources.
Appropriate care in the appropriate environment
Since then, Boston Children’s has taken additional steps, initiating a partnership with nearby Franciscan Children’s Hospital and building a new Mental Wellness Campus that will expand the continuum of care for children with mental health needs and increase the number of available mental health beds, including a specialized unit for children with neurodevelopmental disorders, an area with few programs focused on intensive care in Massachusetts.
Ibejiako sees the study as a call to action for the nation. To her knowledge, this is the first study to describe and evaluate the outcomes of an intervention to address children’s hospital admissions during a national pediatric mental health crisis.
“We all know what these patients need,” Ibesiako says. “We all know there is a crisis and everyone is having a hard time boarding. We recognize that children with mental health issues are in crisis and we need them to be put in the right environment. Let’s do our best to get the right care.”
Boston Children’s supports: Massachusetts Behavioral Health Line, an effort to expand access to mental health care across the state. Call or text 833-773-2445 or use our chat feature for real-time help 24/7.
Learn more about Boston Children’s Hospital’s research and innovation in psychiatry and behavioral health partnerships with neighborhood schools.
